Nutrition counseling increases weight gain among Brazilian children

To assess the impact on child growth of the nutrition-counseling component of the Integrated Management of Childhood Illnesses (IMCI) strategy, a rand omized trial was implemented. All 28 government health centers in a Souther n Brazil city were paired according to baseline nutritional indicators. One center from each pair was randomly selected and its doctors received 20-h training in nutrition counseling. Thirty-three doctors were included and 12 -13 patients < 18 mo of age from each doctor were recruited. The study incl uded testing the knowledge of doctors, observing consultations and visiting the children at home 8, 45 and 180 d after the initial consultation. Mater nal knowledge, practices and adherence to nutritional recommendations were assessed, and anthropometric measurements were taken. Day-long dietary inta ke was evaluated on a subsample of children. Doctors in the intervention gr oup had better knowledge of child nutrition and improved Assessment and cou nseling practices. Maternal recall of recommendations was higher in the int ervention than in the control group, as was satisfaction with the consultat ion. Reported use of recommended foods was also increased. Daily fat intake was higher in the intervention than in the control group; mean daily intak es of energy and zinc also tended to improve. Children 12 mo of age or olde r had improved weight gain and a positive but nonsignificant improvement in length. Nutrition-counseling training improved doctors' performances, mate rnal practices and the diets and weight gain of children. The randomized de sign with blind outcome evaluation strongly supports a causal link. These r esults should be replicated in other settings.